| NPI | 1972574572 |
|---|---|
| Former Name | LAURA L ETTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 21148) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 17046) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2015-05-05 |